MEDICARE: KATHY RADINA M.ED.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LPC-1404	AZ

General Provider Information

NPI Number	:	1992799068
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHY RADINA M.ED.

Provider Business Mailing Address
First Line	:	PO BOX 4410
Second Line	:
City	:	CAVE CREEK
State	:	AZ
Zip	:	85327-4410
Country	:	US
Telephone Number	:	480-488-6096
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 SUNDIAL CIRCLE #2
Second Line	:
City	:	CAREFREE
State	:	AZ
Zip	:	85377
Country	:	US
Telephone Number	:	480-488-6096
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/06/2005
Last Update Date	:	07/08/2007

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